Chester Porter QC

Book Review

A confronting title introduces an important book about psychiatry, a topic which interests most people, but a topic concerning which there is much prejudice and inadequate knowledge among lay people.

My brother was an engineer. That was a precise science, but psychiatry is far from precise. Furthermore, the practitioner is obliged to obtain a lot of information from the patient, who, if mentally ill, is an unreliable raconteur. A veterinary practitioner such as my daughter feeling a dog with experienced fingers gets nothing but reliable information from the patient’s whimpers and growls. The psychiatrist on the other hand is expected to make a reliable diagnosis from information, which is quite likely to be wrong.

This book describes very vividly the limitations and the achievements of modern psychiatry at a time when thinking people must be concerned. Some time ago the mental hospitals were almost emptied, and long term patients were at liberty again, cured by new drugs. A little later it was realised that many had merely exchanged hospitals for prisons and that problems of mental illness were far from solved. Dr. Bell’s book covers the past disappointment and the future hope. The limitations and achievements of psychiatry are related with interesting examples and comments.

He seems to have covered most of the areas of dispute between practitioners. He takes firm positions, which no doubt others will dispute. However the intelligent reader will learn a great deal, even if he or she is not reasonably able to form firm opinions about the many controversies, discussed with clarity and detailed examples. Certainly David Bell does not lack courage in discussing popular ailments and drug company new cures.

He makes what appears to be a convincing case every time he deals with a difficult topic. The writing refrains from being too technical so the lay reader can follow the theme. No one can carefully read this book without learning a lot. Topics include the temptations to prescribe held out by the big drug companies. There are the current favourite ailments (usually involving damages and time off work), which many a weary worker hopes to have. To meet these problems is a very incomplete field of science plagued with controversy.

Most important of all there are those patients with serious mental illness hoping to be the lucky ones for whom there is relief, or even a complete cure.

There is much to be learned from this book and to my mind two ideas stand out:

the first is look for the cause rather than the result;

the second is proceed slowly and cautiously, ever ready to retreat, or even change one’s mind.

One is working in an area of uncertainly and far from complete knowledge.

It is to be hoped that this book will be widely read, and as a result a mystery science will be at least partially revealed.